Linkage to Care Specialist

Job ID
Einstein/Resnick - Bronx
Posting Date
1 month ago(6/29/2020 11:46 AM)
Employee Classification
Position Type
Regular Full-Time




  1. Follow study protocol to link participants who are released from the correctional facility to primary care at the Bronx Transitions Clinic or any other assigned medical clinics.
  2. Provides support, education and care coordination, including accompaniment to medical visits when necessary, to approximately 40-50 participants annually.
  3. Attend all study meetings and communicate with the Bronx Transition Clinic’s “Panel Manager” on a weekly basis.
  4. Conduct specific assessments of participants’ physical activity, dietary habits, tobacco habits and economic resources periodically.
  5. Educate participants with chronic illness, including HIV, about evidence-based standards of care and self-management of their chronic illness.
  6. Document work with participants through appropriate record keeping as described in the study protocol.
  7. Make referrals when participants need additional medical or social services and facilitate access to community services.
  8. Participate in any training as required by the study.
  9. Work in collaboration with partners of the Transition Clinic.
  10. Perform other needs as assigned by supervisor.


POSITION SCOPE:  Provide support, health education, patient follow-up and care coordination in coordination with medical providers and partner community organizations. 


PROBLEM SOLVING: Identifies and determines solutions to routine problems, following established standards and procedures.  Confronts and resolves problematic issues that may arise. 


KNOWLEDGE:  Have knowledge and experience working with a criminal justice population, including knowledge of the state and local correctional systems. Must possess the ability to work with participants, providing health education, identifying support needs and teaching participants how to navigate within the health care system. Have knowledge of opioid use disorder, infectious diseases, and sexually transmitted diseases, HIV prevention and general health information.


CONTACTS: Liaison with the Bronx Transition Clinic medical staff, correctional facility staff, and community partners.  


SUPERVISION:  The CHW will report directly to the principal investigator for the study.




Education:  Minimum of a High school diploma or GED. Must be knowledgeable in opioid use disorder, HIV/HCV transmission and prevention, HIV medications and treatment.


Experience:  Must have lived experience of criminal justice involvement plus two to four years of directly related work experience in a social service agency.  Experience working with formerly incarcerated population preferred. Health education experience strongly preferred.


Related Skills or Knowledge:  Excellent written and verbal communication. Excellent assessment and problem-solving skills are necessary. Basic computer literacy is necessary for data entry. Bi-lingual (Spanish) candidates preferred.


Other requirements:  Must meet approval for Volunteer status clearance for New York City and State correctional facilities.




The work environment described here is representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


While performing the duties of this job, the employee is occasionally required to stand, walk, sit, stoop, use hands or fingers, or feel objects, tools or controls, reach with hands and arms, climb stairs, balance, kneel, talk or hear.  The employee must occasionally lift and/or move up to 10-15 pounds.  Specific vision abilities required by the job include close vision and distance vision.  Must be able to travel locally using public transportation.


The employee must be able to enter and work at prisons and jail and must be able to obtain prison/jail clearance for entry.


Founded in 1955, the Albert Einstein College of Medicine (Einstein) is one of the nation’s premier institutions for medical education, basic research and clinical investigation. A full-time faculty of some 2,000 conducts research, teaches, and delivers health care in every major biomedical specialty. The college has some 730 medical students, 193 Ph.D. students, 106 MD/Ph.D. students and 275 postdoctoral fellows.


Einstein’s major strength, in addition to training physicians and scientists, is its science. During fiscal year 2015, the faculty’s consistently high level of scientific achievement resulted in the awarding of more than $150 million in peer-reviewed grants from the National Institutes of Health (NIH).


Einstein is part of Montefiore Medicine Academic Health System, an integrated academic delivery system comprising seven campuses, including 8 hospitals, a multi-county ambulatory network, a new state-of-the art “hospital without beds”, a skilled nursing facility, school of nursing, home health agency, and the state’s first freestanding emergency department. As the University Hospital for the Albert Einstein College of Medicine, Montefiore is a premier academic health system, employing Einstein’s clinical faculty and training Einstein’s medical students, over 1,300 residents, 420 allied health students, and 1,600 nursing students annually.


We have also been recognized by Forbes as one of the country's best midsize employers in 2019. Forbes ranked Einstein in the top overall nationally among midsize employers. Einstein ranked 3rd within the education category in New York State and 9th nationally among all midsize education employers.


The Albert Einstein College of Medicine is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. Einstein seeks candidates whose skills, and personal and professional experience, have prepared them to contribute to our commitment to diversity and excellence, and the communities we serve.


PRIMARY FUNCTION/PURPOSE: The Linkage to Care Specialist will facilitate access to medical services to formerly incarcerated individuals. For this study, the “Linkage to Care Specialist” will act as a liaison between study participants, the correctional facility, criminal justice agencies, and medical staff at assigned medical clinics. The Linkage to Care Specialist will work independently in providing linkage, education, and care coordination for study participants, but will also work with a team of health care providers at the Bronx Transitions Clinic. The Linkage to Care Specialist will address the medical needs of reentry for participants who have had conflict with the law with the aim of improving health and social outcomes, preventing opioid overdose and reducing recidivism.


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